Change Order Agreement

To ensure that Architectural Surface Designs, Inc. processes your order accurately we request that
all change orders be in writing. Please use this “Change Order Agreement” to document your
change order requests and ensure that all involved parties acknowledge and sign-off on the
attached changes and/or credits and/or additional costs to quotation.

Customer: SM Wilson- Sunrise, Carmel Order # 070160 Date: November 20 2008

Revision 2

I hereby authorize Architectural Surface Designs, Inc to make the following changes from the work
originally set forth in the plans and specifications agreed to in the original purchase agreement.

Change Order #1
 Description: ASD Fabricated 18 vanity tops for Sunrise Independent Living 4th and 3rd floor
facility with 4” hole faucet spreads. Must re-fabricate these vanity tops with 8” hole faucet
spreads. See attached detail for room specifics.
 Re-fabrication of these tops will cause a delay in schedule as ASD has devoted specific molds
for Sunrise, and with current equipment and resources cannot delivery these tops any sooner
than ~2 weeks. This will likewise delay fabrication of 3rd floor deliveries.
 If these tops need to be delivered sooner, ASD will need to modify additional molds, which will
add additional costs to this change request.
 Additional cost to be incurred if both public restroom tops need to be re-fabricated

Work Impacted : Scrap old tops, deliver revised Date of Request: Original 11-6-08
Revised 11-20-08
Cost: $4969.14 (SM Wilson negotiated $1,000 Effective Date: 11-7-08
less than original submission)
Credit: None Requested By: Rob Warner

Change Order #2
Description:

Work Impacted : Date of Request:

Cost: Effective Date:
Credit: Requested By:

Buyer, Client of Buyer, Builder Representative Company Name

SM Wilson, Sunrise Senior Living _________________________________________________

Printed Name Authorized Signature Date

________________________________ ____ _____________________ ___________

Architectural Surface Designs, Inc Representative

Printed Name Authorized Signature Date
________________________________ ____ _____________________ ___________

Please return or fax an executed copy of this form to:

Architectural Surface Designs, Inc 5149 E. 65th Street, Indianapolis, IN
Email: info@asdproducts.com or fax to: 317.255.5636